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Clinical features of postinfectious bronchiolitis obliterans in children undergoing long-term nebulization treatment

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Abstract

Background

Limited data are available in relation to the clinical features of PIBO undergoing prolonged nebulization treatment with budesonide, terbutaline and ipratropium bromide. This retrospective study aimed to outline the features of clinical, high-resolution computed tomography (HRCT) and pulmonary function test (PFT) of PIBO, undergoing maintenance therapy utilizing a triple nebulization treatment and to determine the factors associated with prognosis.

Methods

Children diagnosed with PIBO were followed up between April 2014 and March 2017. The clinical features after maintenance nebulization treatment for 12 months were thereafter summarized.

Results

Thirty patients, 21 boys and 9 girls, were enrolled in the study. The median age of patients was 17.4 months, with a range between 3.0 and 33 months. Persistent coughing and wheezing were detected whilst wheezing and crackles were the common manifestations presented. HRCT scans revealed patchy ground and glass opacity, while PFT showed fixed airway obstruction in all patients. Four patients were lost during follow-up. After treatment, the clinical symptoms were improved greatly in all patients (P < 0.01). The mean increase in the percentage of TPEF%TE and VPEF%VE were improved greatly (P < 0.01). Images of the HRCT scan indicated marked improvements in 18 patients (81.8%) in comparison with scans obtained pre-treatment.

Conclusions

Our data suggest a potential role of long-term nebulization treatment of budesonide, terbutaline, ipratropium bromide on PIBO, due to its efficacy as indicated in the improved clinical symptoms, pulmonary functions and CT manifestations identified in the children. New prospective and controlled studies are required to confirm this proposition.

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References

  1. Smith KJ, Fan LL. Insights into post-infectious bronchiolitis obliterans in children. Thorax. 2006;61:462–3.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  2. Li YN, Liu L, Qiao HM, Cheng H, Cheng HJ. Post-infectious bronchiolitis obliterans in children: a review of 42 cases. BMC Pediatr. 2014;14:238.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  3. Kim JS, Kim CK, Kim SW, Koh YY, Cohen AH, Deterding RR, White CW. Bronchiolitis obliterans in the 1990s in Korea and the United States. Chest. 2001;120:1101–6.

    Article  CAS  PubMed  Google Scholar 

  4. Aleman C, Alegre J, Recio J, Fernandez DST. Bronchiolitis obliterans organizing pneumonia associated with Legionella pneumophila. An Med Interna. 2002;19:133–5.

    CAS  PubMed  Google Scholar 

  5. Castro-Rodriguez JA, Daszenies C, Garcia M, Meyer R, Gonzales R. Adenovirus pneumonia in infants and factors for developing bronchiolitis obliterans: a 5-year follow-up. Pediatr Pulmonol. 2006;41:947–53.

    Article  PubMed  Google Scholar 

  6. Koh YY, Jung DE, Koh JY, Kim JY, Yoo Y, Kim CK. Bronchoalveolar cellularity and interleukin-8 levels in measles bronchiolitis obliterans. Chest. 2007;131:1454–60.

    Article  CAS  PubMed  Google Scholar 

  7. Chiu C, Wong K, Huang Y, Lin T. Bronchiolitis obliterans in children: clinical presentation, therapy and long-term follow-up. J Paediatr Child Health. 2008;44:129–33.

    Article  PubMed  Google Scholar 

  8. Murtagh P, Giubergia V, Viale D, Bauer G, Pena HG. Lower respiratory infections by adenovirus in children. Clinical features and risk factors for bronchiolitis obliterans and mortality. Pediatr Pulmonol. 2009;44:450–6.

    Article  PubMed  Google Scholar 

  9. Mauad T, Dolhnikoff M. Histology of childhood bronchiolitis obliterans. Pediatr Pulmonol. 2002;33:466–74.

    Article  PubMed  Google Scholar 

  10. Fischer GB, Sarria EE, Mattiello R, Mocelin HT, Castro-Rodriguez JA. Post infectious bronchiolitis obliterans in children. Paediatr Respir Rev. 2010;11:233–9.

    Article  PubMed  Google Scholar 

  11. Mattiello R, Sarria EE, Mallol J, Fischer GB, Mocelin H, Bello R, et al. Post-infectious bronchiolitis obliterans: can CT scan findings at early age anticipate lung function? Pediatr Pulmonol. 2010;45:315–9.

    Article  PubMed  Google Scholar 

  12. Colom AJ, Maffey A, Garcia Bournissen F, Teper A. Pulmonary function of a paediatric cohort of patients with postinfectious bronchiolitis obliterans. A long term follow-up. Thorax. 2015;70:169–74.

    PubMed  Google Scholar 

  13. Bosa VL, Mello ED, Mocelin HT, Benedetti FJ, Fischer GB. Assessment of nutritional status in children and adolescents with post-infectious bronchiolitis obliterans. J Pediatr. 2008;84:323–30.

    Google Scholar 

  14. Uyan ZS, Turan I, Ay P, Cakir E, Ozturk E, Gedik AH, et al. Sleep disordered breathing and sleep quality in children with bronchiolitis obliterans. Pediatr Pulmonol. 2016;51:308–15.

    Article  PubMed  Google Scholar 

  15. Cullinan P, Bush A. Growing old(er) with postinfectious bronchiolitis obliterans. Thorax. 2015;70:103–4.

    Article  PubMed  Google Scholar 

  16. Bashoura L, Gupta S, Jain A, Couriel DR, Komanduri KV, Eapen GA, et al. Inhaled corticosteroids stabilize constrictive bronchiolitis after hematopoietic stem cell transplantation. Bone Marrow Transpl. 2008;41:63–7.

    Article  CAS  Google Scholar 

  17. Kim SW, Rhee CK, Kim YJ, Lee S, Kim HJ, Lee JW. Therapeutic effect of budesonide/formoterol, montelukast and N-acetylcysteine for bronchiolitis obliterans syndrome after hematopoietic stem cell transplantation. Respir Res. 2016;17:63.

    Article  PubMed Central  PubMed  Google Scholar 

  18. Tomikawa SO, Adde FV, da Silva Filho LV, Leone C, Rodrigues JC. Follow-up on pediatric patients with bronchiolitis obliterans treated with corticosteroid pulse therapy. Orphanet J Rare Dis. 2014;9:128.

    Article  PubMed Central  PubMed  Google Scholar 

  19. Lobo AL, Guardiano M, Nunes T, Azevedo I, Vaz LG. Post-infectious bronchiolitis obliterans in children. Rev Port Pneumol. 2007;13:495–509.

    Article  PubMed  Google Scholar 

  20. Calabrese C, Corcione N, Rea G, Stefanelli F, Meoli I, Vatrella A. Impact of long-term treatment with inhaled corticosteroids and bronchodilators on lung function in a patient with post-infectious bronchiolitis obliterans. J Bras Pneumol. 2016;42:228–31.

    Article  PubMed Central  PubMed  Google Scholar 

  21. Xie BQ, Wang W, Zhang WQ, Guo XH, Yang MF, Wang L, et al. Ventilation/perfusion scintigraphy in children with post-infectious bronchiolitis obliterans: a pilot study. PLoS One. 2014;9:e98381.

    Article  PubMed Central  PubMed  Google Scholar 

  22. Zhang L, Irion K, Kozakewich H, Reid L, Camargo JJ, da Silva Porto N, et al. Clinical course of postinfectious bronchiolitis obliterans. Pediatr Pulmonol. 2000;29:341–50.

    Article  CAS  PubMed  Google Scholar 

  23. Colom AJ, Teper AM, Vollmer WM, Diette GB. Risk factors for the development of bronchiolitis obliterans in children with bronchiolitis. Thorax. 2006;61:503–6.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  24. Chan PW, Muridan R, Debruyne JA. Bronchiolitis obliterans in children: clinical profile and diagnosis. Respirology. 2000;5:369–75.

    Article  CAS  PubMed  Google Scholar 

  25. Colom AJ, Teper AM. Clinical prediction rule to diagnose post-infectious bronchiolitis obliterans in children. Pediatr Pulmonol. 2009;44:1065–9.

    Article  PubMed  Google Scholar 

  26. Wang X, Liu C, Wang M, Zhang YI, Li H, Liu G. Clinical features of post-infectious bronchiolitis obliterans in children undergoing long-term azithromycin treatment. Exp Ther Med. 2015;9:2379–83.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  27. Rosewich M, Eckrich J, Zielen S. Long-term lung function in postinfectious bronchiolitis obliterans. Thorax. 2015;70:792.

    Article  PubMed  Google Scholar 

  28. Cazzato S, Poletti V, Bernardi F, Loroni L, Bertelli L, Colonna S, et al. Airway inflammation and lung function decline in childhood post-infectious bronchiolitis obliterans. Pediatr Pulmonol. 2008;43:381–390.

    Article  PubMed  Google Scholar 

  29. Rosewich M, Zissler UM, Kheiri T, Voss S, Eickmeier O, Schulze J, et al. Airway inflammation in children and adolescents with bronchiolitis obliterans. Cytokine. 2015;73:156–62.

    Article  CAS  PubMed  Google Scholar 

  30. Eckrich J, Herrmann E, Voss S, Schubert R, Zielen S, Rosewich M. Short-term variation of lung function and airway inflammation in children and adolescents with bronchiolitis obliterans. Lung. 2016;194:571–9.

    Article  PubMed  Google Scholar 

  31. Castro-Rodriguez JA, Giubergia V, Fischer GB, Castanos C, Sarria EE, Gonzalez R, et al. Postinfectious bronchiolitis obliterans in children: the South American contribution. Acta Paediatr. 2014;103:913–21.

    Article  PubMed  Google Scholar 

  32. Yu J. Postinfectious bronchiolitis obliterans in children: lessons from bronchiolitis obliterans after lung transplantation and hematopoietic stem cell transplantation. Korean J Pediatr. 2015;58:459.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  33. Aguerre V, Castanos C, Pena HG, Grenoville M, Murtagh P. Postinfectious bronchiolitis obliterans in children: clinical and pulmonary function findings. Pediatr Pulmonol. 2010;45:1180–5.

    Article  CAS  PubMed  Google Scholar 

  34. Mosquera RA, Hashmi SS, Pacheco SE, Reverdin A, Chevallier J, Colasurdo GN. Dysanaptic growth of lung and airway in children with post-infectious bronchiolitis obliterans. Clin Respir J. 2014;8:63–71.

    Article  PubMed  Google Scholar 

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Funding

No financial or nonfinancial benefits have been received or will be received from any party related directly or indirectly to the subject of this article.

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Authors and Affiliations

  1. Respiratory Department, Children’s Hospital of Fudan University, 399 Wan Yuan Rd, Shanghai, China

    Xiao-Mei Zhang, Ai-Zhen Lu, Li-Ling Qian, Li-Bo Wang & Xiao-Bo Zhang

  2. Radiology Department, Children’s Hospital of Fudan University, 399 Wan Yuan Rd, Shanghai, China

    Hao-Wei Yang

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  1. Xiao-Mei Zhang
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  2. Ai-Zhen Lu
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  4. Li-Ling Qian
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Contributions

XMZ, AZL and HWY had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. XMZ, AZL, and XBZ. conceived and designed the study. XMZ and AZL reviewed the scientific literature, did the statistical analysis, prepared all tables and figures, and wrote the first draft of the report. LLQ, LBW and XBZ reviewed and revised the article. All authors made a critical revision of the manuscript for key intellectual content.

Corresponding author

Correspondence to Xiao-Bo Zhang.

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Ethical approval

This study was approved by the Hospital’s Ethics Committee, and all participants provided written consents.

Conflict of interest

The authors declare that they have no conflict of interest.

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Zhang, XM., Lu, AZ., Yang, HW. et al. Clinical features of postinfectious bronchiolitis obliterans in children undergoing long-term nebulization treatment. World J Pediatr 14, 498–503 (2018). https://doi.org/10.1007/s12519-018-0193-z

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  • DOI: https://doi.org/10.1007/s12519-018-0193-z

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